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Published on: October 23, 2017
Short-term condylar and glenoid fossa changes in infants with Pierre Robin sequence undergoing mandibular distraction
S M Susarla1, E Mercan2, K Evans3
1Division of Plastic and Craniofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Oral and Maxillofacial Surgery, Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA.
Insights
Early mandibular distraction osteogenesis (MDO) in infants with Pierre Robin sequence (PRS) significantly improves condylar and glenoid fossa morphology, normalizing features and aiding airway obstruction management.
Area of Science:
- Craniofacial surgery
- Pediatric orthopedics
- Developmental biology
Background:
- Pierre Robin sequence (PRS) is a congenital condition characterized by mandibular hypoplasia, glossoptosis, and cleft palate, often leading to severe airway obstruction.
- Mandibular distraction osteogenesis (MDO) is a surgical technique used to lengthen the mandible, commonly employed in PRS management.
- Understanding the impact of early MDO on craniofacial morphology is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To evaluate the short-term effects of early MDO (age <4 months) on condylar and glenoid fossa morphology in infants with PRS.
- To compare the craniofacial morphology of infants with PRS undergoing MDO to age-matched controls without facial skeletal dysmorphology.
Main Methods:
- Computed tomography (CT) scans were obtained from infants with PRS who underwent MDO and age-matched control infants.
- Surface/volume, linear, and angular measurements of the condyle and glenoid fossa were performed.
- Morphological parameters were compared between the PRS group (pre- and post-MDO) and the control group.
Main Results:
- Prior to MDO, infants with PRS exhibited smaller condylar articulating surface area and volume, and a more lateral condylar axis compared to controls.
- Following MDO, significant increases in condylar articulating surface area and volume were observed in PRS infants, approaching normal control values.
- MDO resulted in further lateral translation of the condylar axis in PRS infants, a change not seen in normal mandibular growth.
Conclusions:
- Early MDO in infants with PRS leads to substantial normalization of condyle and glenoid fossa morphology.
- The lateral translation of the condylar axis following MDO is a distinct outcome of the surgical intervention.
- These findings support the efficacy of early MDO in improving craniofacial development in infants with PRS.
Abstract:
The purpose was to evaluate short-term changes in condylar and glenoid fossa morphology in infants with Pierre Robin sequence (PRS) undergoing early (age <4 months) mandibular distraction osteogenesis (MDO) for the management of severe airway obstruction. Computed tomography data from infants with PRS who had MDO were compared to those of age-matched control infants without facial skeletal dysmorphology. Surface/volume, linear, and angular measurements of the condyle and glenoid fossa were obtained and compared between infants with PRS and controls. Eleven infants with PRS met the inclusion criteria. There were five female and six male subjects with a mean age at the time of MDO of 41±32 days. Prior to MDO, PRS mandibles had a smaller condylar articulating surface area and volume than age-matched control mandibles, with a more laterally positioned condylar axis (P≤0.05). Following MDO, there were significant increases in condylar articulating surface area and volume, approaching those of normal controls, with further lateral translation of the condylar axis (P≤0.05). Condyle and glenoid fossa morphology is largely normalized following early MDO in infants with PRS. The condylar axis translates laterally as a result of MDO; this change is not observed with mandibular growth in infants without PRS.
